Nursing Home Changes Sought

Nursing homes would have 10 months to comply with new staffing standards that would more than double the minimum hours of nursing care per resident now required by state law, under a plan presented Wednesday by Democratic legislative leaders.

The proposal would allocate $9.5 million to nursing homes in the next fiscal year to phase in an increase in the state's minimum staffing rules, which now require 1.9 hours of daily nursing care per resident — one of the lowest state minimums in the country. Nursing homes would have to provide at least 4.2 hours of daily care per resident as of May 2009 — a requirement that would put Connecticut well above the national average, and in line with a federal recommendation calling for a minimum of 4.1 hours of care.

"No one initiative will solve all of our [nursing home] problems, but we must start somewhere," said Joyce Fontana, an assistant professor of nursing at St. Joseph College in West Hartford who spoke in favor of the proposal at a press conference Wednesday. Increasing the staffing minimum is "a moral response we can be proud of. It is something we as a state can build on," she said.

The state's minimum staffing rule has not been updated in more than 25 years, despite repeated efforts by state Sen. Edith Prague, D-Columbia, and other elderly services advocates to increase the required hours of care.

The new effort was prompted by revelations of serious patient care and financial problems at one of the state's largest nursing home chains, Haven Healthcare, which declared bankruptcy late last year, after a series in The Courant detailed its troubled regulatory record.

Prague said the public outrage over Haven's situation had led lawmakers to propose the increased staffing rule, as well as other measures aimed at improving oversight and financial accountability of the state's 240 licensed nursing homes.

House Speaker James Amann, D- Milford, Senate President Pro Tem Donald E. Williams Jr., D-Brooklyn, Senate Majority Leader Martin Looney, D- New Haven, and other Democratic leaders said the staffing bill would be a first step toward restoring public confidence in nursing home care.

Under the proposal, homes would be required to provide each resident with at least 3.5 hours of direct care a day starting in October; 3.9 hours of care starting in January 2009; and 4.2 hours of care as of May 2009.

The $9.5 million would be targeted to homes that need to hire staff to meet the minimums.

Most of the state's nursing homes already staff well above the existing 1.9-hour minimum.

The most recent federal data show that Connecticut's homes provide an average of about 3.7 hours of care a day per resident — about the same as the national average.

But advocates for the elderly say the outdated staffing rule allows homes too much discretion to operate with reduced nursing staff, without fear of being penalized by the state.

Although the cost of bringing homes up to the new minimums will be blunted next year because of the phase-in, sustaining the higher staffing levels could cost taxpayers more than $30 million in the following year, Williams said.

Once fully in place, the new minimum would mean a staffing ratio of one nurses' aide for every five residents during daytime hours.

Typically, the ratio of nursing staff to residents is now about one for every eight or one for every nine, said Deborah Chernoff, spokeswoman for the New England Health Care Employees Union, District 1199.

Toni Fatone, executive vice president of the Connecticut Association of Health Care Facilities, said that while the nursing home industry supports higher staffing levels, the proposal doesn't provide nearly enough funding — or time — for homes to meet the new minimums.

The $9.5 million "doesn't even come close to enough money," Fatone said. "If they were really committed to staffing, there would be over $100 million in funding to do it and realistic time frames to get it done."

She questioned where new workers would come from, given a shortage of nurses and nurses' aides.

Fatone also rapped lawmakers for proposing a $13 million, or 1 percent, cost-of-living increase for nursing homes, saying that amount falls far short of the industry's increased costs and "sets us up to fail."

The new staffing minimums would be enforced by the state Department of Public Health, which would inspect payroll records and work schedules. Homes that don't meet the minimums would be given time to comply. The proposal also would require nursing homes to post their staff-to-resident ratios in a public location.

Although the state's health code already requires that each nursing home have sufficient staff to ensure that residents receive appropriate care, state health officials have rarely used that provision to penalize homes specifically for understaffing, or to make demands on homes to add staff, records show.

Federal data show that Connecticut in 2006 cited only 2 percent of nursing homes, under federal rules, for failing to provide sufficient nursing staff.

Prague said she expects the state health department to aggressively enforce the new minimums, saying the agency has been too lenient on staffing in the past.

"I want them doing what we expect them to do — enforcement, not sitting back on their hands," she said.

The staffing proposal was welcome news to one nursing home resident who attended Wednesday's announcement. Grace Belige-Curry said that while she has received good care at Newington Health Care Center, the staff seems "overwhelmed."

"I can really feel now there will be a light at the end of the tunnel," she told the crowd of lawmakers, nursing home workers and advocates.

Toby Edelman, senior policy attorney at the Center for Medicare Advocacy, said setting staff-to-resident ratios is the best route to ensuring adequate care. Pouring more money into nursing homes without setting ratios doesn't work to increase staffing levels, she said.

Besides the staffing bill, other proposals would increase financial oversight of nursing homes and provide residents with greater legal protections. One bill would establish an oversight panel to examine and audit the financial records of nursing home companies and identify homes in financial distress — tasks now handled by the Department of Social Services.

Williams said revelations that Haven Healthcare's CEO had diverted millions in corporate assets away from the nursing home chain, to a country music company and other personal ventures, highlights the need for stricter oversight.

"When we increase funding for nursing homes, it should not go to recording studios in Nashville," Williams said. "It should go to employees and quality of care."

-------------------- In the past decade, Haven Healthcare has become one of Connecticut's largest and most prominent nursing home chains, with more than 1,800 beds. But in a three-part series, first published beginning Nov. 18, 2007, the Courant reveals a troubling pattern of deficient...

A former volunteer firefighter in Montgomery County held four fellow firefighters hostage at gunpoint in the Elkins Park section of the township Tuesday morning before being taken into custody, police said.